NPI | 1083271209 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26542) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1002056) |
Enumeration Date | 2019-05-22 |
Last Update Date | 2022-03-25 |